The 2018 budget and appropriations process is in full swing within both chambers of the United States Congress, and it could have significant implications for both veterans with migraine as well as for other patients with the headache disorder. Here is everything we know.

VA Headache Disorders Centers of Excellence

Approved by Senate Appropriations Committee

Veterans are one of the most at-risk populations for migraine and other headache disorders as a result of wartime blast exposure and other head injuries. This not only increases instances of concussion and traumatic brain injury (TBI), but can lead to worsening headache severity more than a decade later(1) as well as long-term disability. As a result of these and other statistics, the US Senate Appropriations Committee has approved its version of a budget bill that allocates $10 million for the US Department of Veterans Affairs to tackle this issue. The funding will be used to create no-less-than five headache centers of excellence to help veterans manage the physical and emotional challenges of migraine.(2) As there are only three UCNS-certified headache specialists affiliated with the VA, this represents a significant step in supporting our servicemen and women with their postwar health and will hopefully lead to more VA doctors becoming certified in neurological and/or headache specialties.

NIH Encouraged to Prioritize Headache Disorders Research

Proposed by House Appropriations Committee

The US House of Representatives Appropriations Committee has made it pretty clear where it would like to see the National Institutes of Health (NIH) focus a portion of its proposed funding: headache disorders. The committee has recommended budget increases to every branch of the NIH to “support innovative research to advance fundamental knowledge and speed the development of new therapies and diagnostics to improve the health of all Americans.”(3) Headache disorders represent a global concern that directly impacts Americans, the committee cites, and continues to be a leading cause of disability. This new directive will hopefully ensure that innovation in treatment options as well as a better understanding of the impact of the condition both remain a critical component of the center’s activities.

This is exciting news, especially given that the anticipated 2018 NIH spending for migraine-related research was only expected to be $14 million, a decrease of 25% from 2017. The proposed bill also seems to directly contradict the President’s previously suggested cuts in total NIH funding, stating the following:

“The Administration’s proposal to drastically reduce and cap reimbursement of facilities and administrative (F&A) costs to research institutions is misguided and would have a devastating impact on biomedical research across the country...The Committee recognizes that there are opportunities to reduce the administrative burden on research institutions through legislative, regulatory, and administrative means, so that NIH can support more researchers who can in turn spend more time on science and less time on paperwork.”

In addition, the committee recommends that the Centers for Disease Control (CDC) also prioritize substantive research on chronic pain conditions. These longitudinal studies are expected to allow for more meaningful treatment strategies and reduce the societal burden related to disability other direct or indirect costs.

What happens next?

There remains a significant amount of legislative back and forth before these bills are officially approved as budgets, and even then there is no guarantee that these initiatives will be enacted. However, we are certainly encouraged by these recommendations. Migraine, headache disorders, and chronic pain are some of the most important health challenges of our time, and it is great to see it getting national attention by our representatives. In addition, it has not gone unnoticed by leading headache specialists, who are acknowledging the importance of these conversations and proposals.